Hybrid Procedure in Living Donor Liver Transplantation

Soyama, Akihiko; Takatsuki, Mitsuhisa; Hidaka, Masaaki; Adachi, Tomohiko; Kitasato, Amane; Kinoshita, Akio; Natsuda, Koji; Baimakhanov, Zhassulan; Kuroki, Tamotsu; Eguchi, Susumu

doi:10.1016/j.transproceed.2015.02.016

Cited by 23 publications

(40 citation statements)

References 12 publications

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“…Essentially, our LAS is an optional extension of OS, making the best use of scopic vision [9,18,21,24]. The concepts of LAS and HALS are distinct from each other [9,10,28].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, a certain incision is required for graft harvesting, although LDLT surgeons try to minimize this incision [18,21,24]. LAS is advantageous in terms of inducing less damage to the abdominal wall and allowing for faster postoperative recovery [18,21,22,24]. Surprisingly, 30% to 50% of complications in LDs are related to abdominal wall damage and include incisional hernia, bowel obstruction, and chronic discomfort [5].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, 60% of LDs develop wound-related symptoms, such as a tightened wound, paresthesia, or a hypertrophic scar even at 1 year after OS, and 35% of them continue to have complaints thereafter [18]. In LAS, an upper middle incision is preferable for minimizing abdominal muscle damage [18,21,22,24], and this incision could allow access to all segments [18,21,22,24]. Skillful surgeons have gradually expanded their surgical indications for LDs, in the order of OS, LAS or HT, and PLS [9,18,21,22,30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Skilled surgeons of Nagasaki University, Japan previously provided us with instructions regarding their LAS procedures [21,22,24], allowing us to develop our own LAS technique. The LAS protocol used in our LDLT program has been approved by our institutional review board (Approved No.…”

Section: Methodsmentioning

confidence: 99%

“…LAS is not considered a type of hand-assisted laparoscopic surgery (HALS), but an extension of OS [9,10,12,13,17,18]. Both preoperative imaging techniques and surgical devices are currently well developed [19,20], and hepatectomy procedures via direct vision from a small midline incision are therefore safe [21,22] if a hanging maneuver is used [18,23]. Hence, we herein focus on surgical procedures performed in preparation for a hanging maneuver.…”

Section: Introductionmentioning

confidence: 99%

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Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision

Hori

Kaido

Iida

et al. 2016

aog

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BackgroundA living donor (LD) for liver transplantation (LT) is the best target for minimally invasive surgery. Laparoscope-assisted surgery (LAS) for LDs has gradually evolved. A donor safety rate of 100% should be guaranteed.MethodsWe began performing LAS for LDs in June 2012. The aim of this report is to describe the surgical procedures of LAS in detail, discuss various tips and pitfalls, and address the potential for a smooth transition to more advanced LAS.ResultsPreoperative planning based on three-dimensional image analysis is a powerful tool for successful surgery. The combination of liver retraction/countertraction and the pressure produced by pneumoperitoneum widens the dissectible/cuttable layer, increasing the safety of LAS. A flexible laparoscope provides excellent magnified vision in both the horizontal view along the inferior vena cava, under adequate liver retraction, and in the lateral view, to harvest left-sided grafts in critical procedures. Intentional omission of painful incisions is beneficial for LDs. Hepatectomy using a smaller midline incision is safe if a hanging maneuver is used. Safe transition from LAS to a hybrid technique involving a combination of pure laparoscopic surgery and subsequent open surgery seems possible.ConclusionLDLT surgeons have a very broad intellectual and technical frontier.

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“…Essentially, our LAS is an optional extension of OS, making the best use of scopic vision [9,18,21,24]. The concepts of LAS and HALS are distinct from each other [9,10,28].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision

Hori

Kaido

Iida

et al. 2016

aog

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Laparoscopic living‐donor hepatectomy: Review of its current status

Marubashi

Nagano

2021

Annals of Gastroent Surgery

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Laparoscopic living donor hepatectomy: a review of current status

Park

Kim

Lee

2015

J Hepatobiliary Pancreat Sci

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Over the last two decades, laparoscopic surgery has been adopted in various surgical fields. Its advantages of reduced blood loss, reduced postoperative morbidity, shorter hospital stay, and excellent cosmetic outcome compared with conventional open surgery are well validated. In comparison with other abdominal organs, laparoscopic hepatectomy has developed relatively slowly due to the potential for massive bleeding, technical difficulties and a protracted learning curve. Furthermore, applications to liver graft procurement in living donor liver transplantation (LDLT) have been delayed significantly due to concerns about donor safety, graft outcome and the need for expertise in both laparoscopic liver surgery and LDLT. Now, laparoscopic left lateral sectionectomy in adult-to-pediatric LDLT is considered the standard of care in some experienced centers. Currently, the shift in application has been towards left lobe and right lobe graft procurement in adult LDLT from left lateral section in pediatric LDLT. However, the number of cases is too small to validate the safety and reproducibility. The most important concern in LDLT is donor safety. Even though a few studies reported the technical feasibility and comparable outcomes to conventional open surgery, careful validating through larger sample sized studies is needed to achieve standardization and wide application.

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Hybrid Procedure in Living Donor Liver Transplantation

Abstract: Background

Cited by 23 publications

References 12 publications

Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision

Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision

Laparoscopic living‐donor hepatectomy: Review of its current status

Laparoscopic living donor hepatectomy: a review of current status

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